Abstract
After tooth extraction, a remodelling process of the edentulous bone begins, and reconstructive procedure may be needed to perform an implant placement with fixed prosthetic rehabilitation.
There are several methods available to augment the atrophic ridge in horizontal or vertical direction, including autologous onlay bone grafting, sinus/nasal lift, distraction osteogenesis, split crest technique.
In 1997, some authors reported that in an animal model, the cortical perforations of the autologous graft and positioning the graft orientated with the cortical portion towards the recipient site could have.
Following these observations, a surgical case of a Single Overturning of Ridge (SOoR) for horizontal bone augmentation in maxilla with immediate implant placement was performed in 2002 and after a long follow-up, the bone volume is maintenance, and the success of the implant-prosthetic rehabilitation are shown in this case report.
Highlights
- •
The autologous bone is a method to augment atrophic bone ridge withosteoconductive, osteoinductive, and osteogenic proprieties.
- •
The overturning of the donor bone block versus the receipt bone site could be an innovative technique to reduce the bone graft resorption.
- •
Oral surgeons and dental practitioner should reduce the biomaterials use thanks to innovative surgical techniques to reconstruct bone.
1
Introduction
After tooth extraction, a remodelling process of the edentulous bone begins due to the healing of the soft tissue, the lack of function and the blood supply of the missing tooth [ ].
Bone loss extends across the alveolar socket, in both vertical and horizontal directions, mostly buccally, bringing about a tridimensional resorption, as described by several respected scientific studies in literatures [ ].
This process is most evident during the first year and continues for a lifetime; as a result, the atrophic residual ridge may be too palatal, making the positioning of future implant-prosthetic rehabilitation more difficult.
Several techniques are used to reduce bone resorption, especially in the first year: mini-invasive surgery that preserves the bone walls during the extraction; sutures or collagen and membrane; or immediate implant placement [ ].
Socket preservation may be not sufficient and, especially if a site has been edentulous for many years, bone reconstruction techniques are needed.
There are several methods available to augment the atrophic ridge, including autologous onlay bone grafting, sinus/nasal lift, distraction osteogenesis, guided bone regeneration, split crest technique and interpositional grafting [ ].
Autologous bone grafts can be classified into two main categories: treatment of bone gaps (inlay) and bone projection (onlay). They have several biological advantages in terms of osteoconductive, osteoinductive, and osteogenic proprieties. They may be necessary in larger bone defects in particular and are considered immunologically inert [ ].
The osteogenetic potential potential of the periosteum of autogeneic bone grafts has been studied in literature and the orientation of host-graft bone marrow has been reported to be one of the most important factors that can influence the incorporation and the volumetric maintenance of graft size.
In 1997, Gordh M. and co-workers reported that in an animal model (Lewis rats), the cortical perforations of the graft induced a migration of the recipient bone marrow into it; in addition, better results in terms of volume persistency were observed if the graft cortical bone was orientated with the cortical portion towards the site of the perforated cortical recipient [ ].
Following these observations, a surgical case of a Single Overturning of Ridge (SOoR) for horizontal bone augmentation in maxilla with immediate implant placement was performed in 2002 with a 18-year follow-up.
Positioning an autogenous bone graft orientated taking into account these indications may be clinically useful to improve the long-term success of implant placement after bone reconstruction in different conditions.
2
Case presentation
The patient aged 45-year-old, male, smoker, in June 2002, requested the masticatory, phonetic and aesthetic restoration of the edentulism in area 14 ( Fig. 1 a). The extraoral examination did not reveal any facial asymmetry, but the intraoral examination showed the vestibular deficiency due to the volumetric bone-loss in the edentulous area with a decrease in the bucco-lingual space between element 13 and 15. The mesio-distal distance between 13 and 15 was of 11mm and the bucco-lingual space was of 4mm. The patient had no systemic disease or other contraindication to rehabilitate the edentulous site by dental implants and fixed prosthetic rehabilitation. Plus having no urgency, a pre-prosthetic orthodontic treatment was opted to restore an adequate mesio-distal space between 13 and 15, followed by an implant insertion and contextual horizontal reconstruction of the bone crest.
Stay updated, free dental videos. Join our Telegram channel
VIDEdental - Online dental courses
